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2206. In a Non-urban Hepatitis C Cohort, Linkage to an Infectious Diseases Clinic with Embedded Services Is Associated with Better Outcomes Than Linkage to a Gastroenterology HCV Clinic Without These Services for Those with Substance Abuse

Authors :
Jacqueline E. Sherbuk
Terry Knick
Rebecca Dillingham
Kathleen A McManus
Elizabeth T. Rogawski
Zachary Henry
Source :
Open Forum Infectious Diseases
Publication Year :
2018
Publisher :
Oxford University Press, 2018.

Abstract

Background Hepatitis C virus (HCV) infection is now curable for most individuals and national goals for elimination have been established. Transmission remains ongoing, particularly in non-urban regions affected by the opioid epidemic. To reach elimination goals, barriers to treatment must be identified with a priority placed on those with substance abuse. Methods In this retrospective cohort study of all individuals with chronic HCV from 2010 to 2016 at a large medical center serving a predominately non-urban population, we identified patient and clinic characteristics associated with our primary outcome, sustained virologic response (SVR). We performed a subgroup analysis for those with documented substance abuse. Results SVR was achieved in 1,544 (41%) of 3,790 people with chronic HCV (Figure 1). In a multivariate Poisson regression model adjusted for patient demographics and year of diagnosis, SVR was less likely in those with substance abuse (IRR 0.8, 95% CI 0.7–0.9). In the subgroup analysis of those with substance abuse (N = 682), SVR rates were higher in those linked to the infectious diseases clinic, which has embedded support services, than in those linked to gastroenterology, which does not (IRR 1.4, 95% CI 1.1–1.9) (table). Higher SVR rates were driven by an increased rate of medication prescribing in those linked to infectious diseases (IRR 1.3, 95% CI 1.1–1.6) (Figure 2). Conclusion Those with substance abuse, a high priority population for treatment of HCV, had better outcomes when receiving care in a clinic with embedded support services. Figure 1. Hepatitis C cascade of care. Table. Factors Associated with SVR in a Multivariable Poisson Regression Model Among Those with Substance Abuse Linked to Care (N = 458) Incidence Rate Ratio* (95% CI) P Hepatitis C clinic Gastroenterology 1 (ref) - Infectious diseases 1.4 (1.1–1.9) 0.01 Diagnosis characteristics Outpatient diagnosis 1.5 (1.1–2.1) 0.01 * Incidence rate ratios are adjusted for patient demographics (age, sex, race, proximity to medical center, financial status, insurance type), diagnosis year and comorbidities (cirrhosis, hepatocellular carcinoma, HIV, hepatitis B) in addition to variables shown in table above. Figure 2. HCV cascade of care for those with substance abuse linked to care. Disclosures All authors: No reported disclosures.

Details

Language :
English
ISSN :
23288957
Volume :
5
Issue :
Suppl 1
Database :
OpenAIRE
Journal :
Open Forum Infectious Diseases
Accession number :
edsair.doi.dedup.....e08e8edfebcf305bdd3730a1bbd0087f